Vaccines
Work on an effective HIV vaccine continues throughout the world. Dr. Gary Nabel, director of the NIH HIV Research Center reported that there are seventy Phase I trials, five Phase II trials, and two Phase III trials currently being conducted. While results are promising, Nabel reports two big questions arising from these studies; how long will immunity to HIV last, and will HIV become resistant to the vaccines? According to Nabel, much work is yet to be done.
Hepatitis C Treatment
Hepatitis C co-infection is of course a continuing problem in the treatment of HIV. Dr. Mark Sulkowski reports that while the standard treatments of Interferon and Ribavirin continue to be effective, new, longer acting drugs are emerging that are effective and easier to take. Sulkowski outlined criteria for the treatment of Hepatitis C in the HIV infected person. Treatment should be considered if the HIV infection is stable, CD4 counts are good, liver disease is becoming symptomatic, or the patient is experiencing recurring liver toxicity from HIV drugs.
HIV Treatment in Pregnant Women
With the increased use of AZT and other drugs in pregnancy, vertical transmission from mother to newborn has been dramatically reduced. Dr. Mary Jo O'Sullivan offered guidelines in the treatment of pregnant women who are infected with HIV. According to O'Sullivan, all pregnant women should be offered an HIV test early in the pregnancy, if the mother is HIV infected, basic labs should be drawn in the first visit, specifically toxo and CMV titers. In addition a PPD test should be applied. Pregnant women should be on antiretroviral therapy and in advanced HIV disease, PCP and MAC prophylaxis should be started. Cesarean section should be done if viral loads are elevated, if prenatal care started late(>38 weeks), if AZT was not taken or if the patient request a C-section. Finally, breast feeding should be avoided, antiretrovirals should be continued post-partum, and of course the newborn should get immediate follow-up.
Where Did HIV Come From?
For some time, the general consensus has been that HIV first made its way into the human species through polio vaccines in Central Africa in the late 1950's. Now one researcher has suggested that HIV actually originated from the SIV (Simian Immunodeficiency Virus) in the 1930's. Examination of hundreds of African tribe family trees has cast a doubt upon the polio vaccine theory. In fact, experts are going to convene later this year to discuss both theories.
The Risks of Oral Sex
A recent study of gay men in San Francisco now indicates that about 8% of new cases of recent HIV infection have been transmitted by way of oral sex. Experts are concerned that this may indicate a complacent attitude emerging in the gay population regarding the need for safe sex. The study showed that the new cases transmitted via oral sex were from performing oral sex without condoms. Those receiving oral sex showed no increased incidence of infection.
